Organisational Justice and Organisational Justice and workers’ healthworkers’ health

Findings from Whitehall II and other studies

Jane E. Ferrie

Department of Epidemiology and Public Health

University College London

Social Justice or FairnessSocial Justice or Fairness

the quality of treating people equally or in a way that is right and

reasonable

Fundamental behaviour?Fundamental behaviour?

the brown capuchin monkey(Cebus apella)

published in Nature 2003

Early evolutionary origin of

aversion to injustice?

ExperimentExperiment Monkeys were taught in pairs to give a token to the experimenter. In return they were given a reward of food. The food could be highly prized (high reward) or less exciting (low reward).

When the monkeys saw that both monkeys in the pair got the same reward in exchange for their token, 95% happily exchanged their token for the reward.

When the monkeys witnessed their partner get a high value reward for equal effort over half of them refused to participate and would not hand in their tokens for exchange.

The refusal rate increased to 80% if the monkeys witnessed their partner get high value reward without handing the token to the experimenter at all.

Brosnan & de Waal. Nature 2003

Experiments in humansExperiments in humansUsing neoroimaging studies have shown that unfair transactions activate the bilateral anterior insula, areas of the brain associated with negative emotional states.

Anterior insula activation is consistently seen in neuroimaging studies of pain and distress, hunger and thirst, and autonomic arousal – one of the responses to stress.

Sanfey et al

Science 2003

General unfairness or injusticeGeneral unfairness or injustice

1.00 1.00 1.00

1.55

1.32

1.54

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

New heart attack Poor physicalfunctioning

Poor mental functioning

Noinjustice

Highinjustice

Odds ratio*

De Vogli et al (2007) J Epidemiology and Community Health*adjusted for socio-demographic, psychosocial andbehavioural risk factors and health at baseline

Justice

Organisational justiceOrganisational justice

refers to the extent to which workers or employees are treated with justice at their

workplace

Organisational Justice Organisational Justice ComponentsComponents

• Procedural component– decision-making procedures include input from

affected parties, are consistently applied, open and ethical

• Relational component– respectful and considerate treatment of workers

and employees by their supervisors

1.00 1.00 1.00 1.00

0.60

0.48

0.77

0.87

0.00

0.20

0.40

0.60

0.80

1.00

Poor self-ratedhealth

Poor mental health Long-termsickness absence

Short-termsickness absence

Bottomquartile

Topquartile

Rate*/ odds ratio*

Elovainio, Kivimäki, Vahtera (2001) Am J Public Health*adjusted for demographic andbehavioural risk factors

Organisational justice

Early workEarly work

Depressive disordersDepressive disorders

Lopez et al. Global burden of disease and risk factors WHO 2006

The leading cause of YLD (years of healthy life lost as a result of disability)

in high-income countries

Cause YLD (millions of years)

Percent of total YLD

1. Unipolar depressive disorders 8.4 11.8

2. Alzheimer's and other dementias 6.3 8.9

3. Hearing loss, adult onset 5.4 7.6

4. Alcohol use disorders 3.8 5.3

5. Osteoarthritis 3.8 5.3

6. Cerebrovascular disease 3.5 4.9

7. Chronic obstructive pulmonary disease 2.9 4.0

8. Diabetes mellitus 2.3 3.2

9. Endocrine disorders 1.7 2.4

10. Vision disorders, age-related 1.5 2.1

10 leading causes of YLD* (millions of years) 10 leading causes of YLD* (millions of years) in high-income countries (WHO 2006)in high-income countries (WHO 2006)

Lopez et al. Global burden of disease and risk factors 2006

*Years of healthy life lost as a result of disability

1.011.13

1.27

1.43

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Low stressHigh stress

Lack of control Job demands Job strain Injustice

Organisational justice, other work stressors Organisational justice, other work stressors and newly diagnosed depressionand newly diagnosed depression

Ylipaavalniemi, Kivimäki et al. Soc Sci Med 2005.

Source of stress

Odds ratio

Does self-reported justice reflect actual managerial treatment

... or the characteristics of the worker?

Individual and work unit level assessment of Individual and work unit level assessment of organisational justiceorganisational justice

Source: Kivimäki et al. (2003). Psychological Medicine

Odds ratios (95% confidence intervals) for new doctor-diagnosed depressive disorders for levels of procedural justice.

Adjusted for

Characteristic* Unadjusted age and salary +mental distress at baseline†

Organisational justice (individual score)

high 1.00 1.00 1.00 low 1.91 (1.14 to 3.19) 1.90 (1.14 to 3.17) 1.73 (1.02 to 2.93)

Organisational justice (work unit mean score‡)

high 1.00 1.00 1.00 low 1.73 (1.48 to 2.03) 1.77 (1.52 to 2.07) 1.65 (1.36 to 2.00)

*High and low levels of procedural justice refer to +1 SD and –1 SD, respectively. †The 12-item General health questionnaire score four or more ‡The work unit mean score of procedural justice applied to all members of the work unit.

Cardiovascular diseaseCardiovascular disease

The leading cause of premature deathin high income countries

Organisational justice and cardiovascular Organisational justice and cardiovascular disease in the Whitehall II studydisease in the Whitehall II study

Longitudinal study of 6,442 men, British civil servants aged 35 to 55 years who had no prevalent CHD at baseline

1985 – 1988 Baseline screening (Phase 1) CHD risk factors, organizational justice & work stress

1989 Questionnaire only (Phase 2) Organizational justice & work stress

1990 – 1999 Follow-up, clinical records (after Phase 2) Clinical records of CHD death, first non-fatal myocardial infarction or definite angina (250 incident CHD cases during the mean follow-up of 8.7 years)

Kivimäki et al. Arch Intern Med. 2005;165:2214-2220.

0

0.25

0.5

0.75

1

Low Intermediate High

Risk for Coronary Heart DiseaseRisk for Coronary Heart Disease

Organizational Justice

Haz

ard

Rat

io

Kivimäki et al. Arch Intern Med. 2005;165:2214-2220.

1.001.05 (95% CI 0.78, 1.41)

0.65 (95% CI 0.47, 0.91)

Unfair supervisors can raise your blood pressureUnfair supervisors can raise your blood pressure

80

100

120

140

Non-work day

Experimentalgroup

Control group

80

100

120

140

Work day, non-favouredsupervisor

Experimentalgroup

Control group

Systolic BP

80

100

120

140

Work day, favouredsupervisor

Experimentalgroup

Control group

12 mm Hg higher increases in systolic BP during workdays under less favoured supervisor than those of the control group (p=0.001).1

15 mm Hg higher systolic BP during workdays under a less favoured supervisor compared to a favoured supervisor (p=0.001).2

1

2

Wager et al. Occup Environ Med 2003;60:468-474

Relational justice and CVD death Relational justice and CVD death or hosptiatisation for back disordersor hosptiatisation for back disorders

Cardiovascular mortality

Hazard Ratio (adj. for age, sex, job strain, ERI)

Kaila-Kangas, Kivimäki et al. the Valmet Study. Spine 2005

1.0 1.0 (0.5-2.3)

Hospitalization for back disorders (not intervertebral disc

disorders) Hazard Ratio

0

0.2

0.4

0.6

0.8

1

1.2

Low High

1.0

0.4 (0.2-0.8)

"My supervisor treats me fairly" Supervisory support

0

0.2

0.4

0.6

0.8

1

1.2

Seldom Often/ always

0.6 (0.3-0.9)

1.0

Elovainio, Leino-Arjas, Vahtera, Kivimäki. the Valmet Study. J Psychosom Res 2006

Does a change in organisational Does a change in organisational justice lead to a change in health?justice lead to a change in health?

0.00

0.25

0.50

0.75

1.00

1.25

1.50

1.75

Adversechange

No change Favourablechange

MenWomen

Change in Organisational JusticeChange in Organisational Justice

Odds of new-onset minor psychiatric morbidity

Ferrie et al. Occup Environ Med 2006 Kivimäki et al. J Epidemiol.Comm.Health 2004

0

0.25

0.5

0.75

1

1.25

1.5

Adversechange

No change Favourablechange

Odds of poor physical health

1.23 (1.01-1.49)

0.61 (0.50-0.74)

1.00

High justice ------------- Low Justice

• Commitment• Don’t leave job• Job performance• Conflict resolution• Decision acceptance• Job satisfaction

• Retaliation• Withdrawal• Theft• Stress• (C) overt

disobedience

Other effects of organisational justiceOther effects of organisational justice

Greenberg & Cropanzano 2001

SummarySummary

• Organisational injustice is a workplace stressor• It has been shown to be associated with

minor psychiatric disorder and depressionpoor physical healthcoronary heart diseasehospitalisation for back problemssickness absencepremature cardiovascular death poor organisational outcomes

• Levels of organisational justice can be improved• Higher levels of justice improve health, decrease

sickness absence and improve organisational outcomes